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Öğe A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150?ml(SAGE Publications, 2021) Karaköse, Ayhan; Yitgin, YasinIntroduction: To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90–150?ml. Methods: In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Results: Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. Conclusions: BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90–150?mlÖğe Effects of repeated use of disposable FURS on efficiency, safety and cost analysis(Ondokuz Mayis Universitesi, 2022) Yitgin, Yasin; Karaköse, AyhanIn this study, we aimed to examine cost analysis and evaluate the results of retrograde intrarenal surgery (RIRS) performed with reusable and disposable flexible ureteroscope (FURS) devices in our clinic. In total, we included 96 patients who underwent RIRS surgery for kidney stones with reusable FURS (n = 49) and disposable FURS (n = 47). There were noted preoperative demographic data and stone characteristics of the patients. Also, operation time, fluoroscopy time, hospitalization time, urethral catheter removal time, return to work time, complication rates and cost per procedure were collected and analyzed. There were no significant differences between each groups in terms of demographic characteristics of retrospectively analyzed the data of 96 patients. In addition, the comparison made in terms of operative and postoperative results in both groups was similar. We determined significant difference for mean cost per case compared two groups. There were cost per case $ 293,87 in group 1 and $ 191,48 in group 2. We determined that the repeated use of disposable FURS compared in terms of cost analysis is a safe, effective and low cost method without increasing the infection frequency. © 2022 Ondokuz Mayis Universitesi. All rights reserved.Öğe Inguinal Fistula by Suture Granuloma Post Microsurgical Varicocelectomy: A Rare Entity(2022) Yitgin, Yasin; Karaköse, AyhanVaricocele is dilatation and tortuosity of the vessels in the pampiniform plexus of spermatic cord and occurs in 11.7% of adult men. Varicocelectomy may lead to various complications such as hydrocele, testicular atrophy, haematoma, infection, damage of nerves and recurrence. A 22-year-old man presented after varicocelectomy with a rare postoperative complication of a fistula. The fistula tract was removed en bloc. The patient had a history of varicocelectomy, suggesting suture reaction. The fact that it is a rare complication of varicocelectomy makes our case interesting.Öğe Is access sheath essential for safety and effective retrograde intrarenal stone surgery ?(MedGen, 2021) Yitgin, Yasin; Yitgin, Emine; Verep, Samed; Gasimov, Kamranbay; Tefik, Tzevat; Karaköse, AyhanObjective: To evaluate the results of retrograde intrarenal surgery (RIRS) with flexible ureteroscope (f-URS), using ureteral access sheath and without the sheath. Study Design: Descriptive study. Place and Duration of the Study: Kesan State Hospital, Edirne, Turkey, between February 2019 and May 2020. Methodology: Patients treated with RIRS for renal and proximal ureteral stone were evaluated. Two groups were formed that used ureteral access sheath or not. Operation and fluoroscopy times, postoperative complications and stone-free rates were compared. Results: Group 1 consisted of 51 patients were operated with, using ureteral access sheath; and Group 2 having 62 patients, were operated without using ureteral access sheath. The mean volume of the stones was 1135 mm3 (73-7491 mm3) in the group without access sheath and 1273 mm3 (251-3635 mm3) in the group with access sheath. The mean operation time was 55 minutes (20-115 min) in the group without access sheath, and 70 minutes (30-125 min) in the group with access sheath. Postoperative febrile UTI was found in 5 (8%) of the patients without access sheath, and in 4 (8%) of the patients with access sheath (p=0.733). The stone-free rate of the patients with radiological controls was 58 (93%) in the group without access sheath and 46 (90%) in the group with access sheath (p=0.306). Fluoroscopy timings were 2.7 seconds (0-8 sec) in the group without access sheath and 8.4 seconds (2-20 sec) in the group with access sheath (p=0.001). Conclusion: UAS usage has no marked impact on SFR, complication rate and operation time. RIRS can be performed safely and effectively without using UAS.Öğe Our experience of retrograde intrarenal surgery in the treatment of upper urinary tract stones(DergiPark, 2021) Yitgin, Yasin; Karaköse, Ayhan; Akdeniz, EkremAmaç: Bu çalışmada böbrek veya proksimal üreter taşı nedeniyle retrograd intrarenal cerrahi (RİRC) uyguladığımız hastaların sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Mart 2019 ile Mayıs 2020 tarihleri arasında böbrek ve proksimal üreter taşlarına yönelik RİRC uygulanan 99 hastanın demografik, klinik, operatif ve postoperatif verileri retrospektif olarak değerlendirildi. Tüm hastalara kontrastsız bilgisayarlı tomografi yapılarak taş lokalizasyonu ve taş boyutu değerlendirildi. Postoperatif kontrolde, radyolojik olarak taş olmaması veya 2 mm ve altı fragmanlar taşsızlık olarak kabul edildi. Bulgular: Çalışmaya yaş ortalaması 44,9 ± 13,1 yıl olan toplam 99 hasta alındı. Hastaların 60’ı (60,6%) erkek ve 39’u (39,4%) kadındı. 48 (%48,4) hastaya sağ, 50 (%50,5) hastaya sol ve bir (%1,1) hastaya bilateral RİRC operasyonu yapıldı. 78 (% 78,8) hastanın taşı böbrekte iken, 21 (% 21,2) hastanın taşı proksimal üreterdeydi. Ortalama taş büyüklüğü 18,5 ± 6,9 mm ve ortalama ameliyat süresi 70,6 ± 23,8 dakika olarak bulundu. Ameliyat sırasında ve sonrasında hastalarda majör bir komplikasyon gelişmedi. Toplam 90 hastada taşsızlık sağlandı ve genel başarı oranımız % 90,9 olarak bulundu. Sonuç: Gelişen teknoloji ve artan deneyim ile birlikte RİRC üst üriner sistem taşlarının tedavisinde düşük komplikasyon ve yüksek taşsızlık oranları ile oldukça başarılı bir tedavi yöntemi olduğunu düşünmekteyiz.Öğe Papillary urothelial carcinoma arising from ureterocele: is it a rare occurrence?(College of Physicians and Surgeons Pakistan, 2022) Karaköse, Ayhan; Akdeniz, EkremVarious hydronephrotic, dysplastic or clinical pathologies can accompany ureterocele, which is a cystic dilatation of the intravesical part of the submucosal ureter. However, the development of cancer in the ureterocele is highly unusual. Hematuria is the most common sign, although imaging can also indicate alterations in the wall of the ureterocele. Unfortunately, there is no current guideline for the management of papillary urothelial carcinoma arising from ureterocele. Non-muscle-invasive bladder cancer treatment and follow-up protocols are classically applied. However, the anatomical structure of the ureterocele differs from that of normal bladder tissue. It is unclear whether this difference represents a risk in terms of deep tissue tumour invasion. In addition, tumour cells may migrate to the upper urinary tract due to urinary reflux developing following tumour resection. The management of papillary urothelial carcinoma arising from ureterocele must therefore be specific to that condition. However, this depends on an increase in the number of patients reported in the literature. Our review of the literature revealed very few reports. The present study is therefore particularly valuable from that perspective and describes the clinical management of a patient developing papillary urothelial carcinoma in ureterocele.Öğe Penile rehabilitation with low-intensity extracorporeal shock wave therapy in patients after prostate cancer surgery. Early physiological changes and postoperative follow-up outcomes(WILEY, 2021) Karaköse, Ayhan; Yiğit, YasinIntroduction: To investigate the efficacy, safety, and postoperative outcomes of using tadalafil and Li-ESWT on penile rehabilitation and preventing urinary incontinence after radical prostatectomy. Methods: In total, we included total 66 patients who used only tadalafil (n=32) in group 1 and used tadalafil and treated by Li-ESWT (n=34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularization by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value<0.05 was considered significant. Results: Preoperative demographic characteristics were similar in the 2 groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared to group 1. Also, there was a significant decrease in incontinence rate in group 2 compared to group 1 in the sixth month. Conclusions: Combined using of tadalafil and Low-intensity Extracorporeal Shock Wave Therapy (Li-ESWT) are highly effective and safety to treatment erectile dysfunction and prevent urinary incontinence after prostate cancer surgery.Öğe Retrograde Intrarenal Surgery Without JJ Stent Placement in Selected Cases of Renal Stones of 1 cm or Less Requirement of Ureteral Catheterization: Retrospective Observational Study(2023) Karaköse, Ayhan; Yitgin, YasinABS TRACT Objective: To evaluate the safety, efficacy of without JJ stent of retrograde intrarenal surgery (RIRS) for the management of renal stones of 1 cm or less, and to determine the advantages and disadvantages. Material and Methods: The data of 103 patients who underwent uncomplicated RIRS for kidney stones of 1 cm or less were retrospectively analyzed. We formed 3 groups. Group 1 consisted of 33 patients were not placed JJ stent, Group 2 consisted of 36 patients were placed open-tip ureteral stent and Group 3 consisted of 34 patients were placed JJ stent in the RIRS procedure. Demographic data of patients and stone characters, as well as operative and postoperative data were analysed. Postoperative pain in all patients was evaluated using visual analog scale (VAS). Results: There were no significant differences between the groups for demographic data and stone characteristics. While the VAS scores were significantly higher in Group 1 in the early postoperative period (first 24 hours), a significant higher was found in Group 3 in the postoperative 1st week control. There were no significant difference between the 3 groups in terms postoperative febrile urinary tract infection. Conclusion: Although there may be an increase in the need for analgesia in the early postoperative period, we support that effective and safe RIRS can be performed without JJ stent placement in selected cases. It should be kept in mind that there are no JJ stent symptoms and no additional intervention is required for its removal.Öğe Small cell prostate cancer: a very rare entity(Ondokuz Mayis Universitesi, 2021) Karaköse, Ayhan; Arslan, Ç?gatay; Şahin, Erkan; Ortaç, R.Small cell prostate cancer which is associated with a high disease specific mortality is a rare disorder accounting for less than 1% of all prostate cancers. We present here a case of 64 years old male patient presented with lower urinary tract symptoms. The prostate needle biopsy result was reported as prostate adenocarcinoma (predominant component small cell carcinoma) Gleason 5 + 3=8 (eight). Chemotherapy and radiotherapy were planned. The patient was asymptomatic 8 months after treatment. He died 13 months after initial diagnosis because of the metastatic lesions.Öğe Üst üriner sistem taşları tedavisinde retrograd intrarenal cerrahi deneyimlerimiz(DergiPark, 2021) Yitgin, Yasin; Karaköse, Ayhan; Akdeniz, EkremAmaç: Bu çalışmada böbrek veya proksimal üreter taşı nedeniyle retrograd intrarenal cerrahi (RİRC) uyguladığımız hastaların sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Mart 2019 ile Mayıs 2020 tarihleri arasında böbrek ve proksimal üreter taşlarına yönelik RİRC uygulanan 99 hastanın demografik, klinik, operatif ve postoperatif verileri retrospektif olarak değerlendirildi. Tüm hastalara kontrastsız bilgisayarlı tomografi yapılarak taş lokalizasyonu ve taş boyutu değerlendirildi. Postoperatif kontrolde, radyolojik olarak taş olmaması veya 2 mm ve altı fragmanlar taşsızlık olarak kabul edildi. Bulgular: Çalışmaya yaş ortalaması 44,9 ± 13,1 yıl (20 - 74) olan toplam 99 hasta alındı. Hastaların 60’ı (60,6%) erkek ve 39’u (39,4%) kadındı. 48 (%48,4) hastaya sağ, 50 (%50,5) hastaya sol ve bir (%1,1) hastaya bilateral RİRC operasyonu yapıldı. 78 (% 78,8) hastanın taşı böbrekte iken, 21 (% 21,2) hastanın taşı proksimal üreterdeydi. Ortalama taş büyüklüğü 18,5 ± 6,9 mm (7 - 35) ve ortalama ameliyat süresi 70,6 ± 23,8 dakika (40 - 125) olarak bulundu. Ameliyat sırasında ve sonrasında hastalarda majör bir komplikasyon gelişmedi. Toplam 90 hastada taşsızlık sağlandı ve genel başarı oranımız % 90,9 olarak bulundu. Sonuç: Gelişen teknoloji ve artan deneyim ile birlikte RİRC üst üriner sistem taşlarının tedavisinde düşük komplikasyon ve yüksek taşsızlık oranları ile oldukça başarılı bir tedavi yöntemi olduğunu düşünmekteyiz.
